Depression

Feeling sad or “blue” can be normal, appropriate and even necessary in response to a setback, loss or disappointment. Depression, however, is more than feeling sad. It is usually characterized by unshakeable feelings of helplessness, hopelessness or despair. If you are depressed, you may lose interest in your favorite activities; have difficulty concentrating; or experience changes in appetite, weight or sleep patterns. Severe depression may lead to intrusive thoughts of death or suicide, or the urge to self-harm. In most cases, depression does not resolve on its own. However, it is extremely treatable—80% of individuals who seek treatment for depression make a full recovery.

Depression can happen to anyone of any age, race, class or gender, but is diagnosed slightly more often in women than men. Once you experience depression, there’s a 50% chance you’ll become depressed again; once you experience two episodes, there’s a 70% chance you’ll become depressed again.

Depression often co-occurs with certain conditions, like chronic pain, diabetes, and after a heart attack or stroke. It can also be triggered by the hormonal fluctuations that occur during perimenopause and menopause and/or by the secondary symptoms associated with menopause (e.g., decreased libido, night sweats, or weight gain).
Behavior:
  • Try to identify specific triggers that might be causing or aggravating your depression: sleep deprivation, grief due to loss, substance use (by yourself or others), problems in relationships, seasonal light deprivation (especially during the winter months), stress, vitamin deficiencies and medications. Change what you can, and if you get stuck, talk to a health care provider or counselor.
  • If you notice one particular trigger outweighs any others, find a self-help or support group that specializes in that particular issue. Research shows that connecting with a like-minded community can provide substantial healing and support.
  • Pay attention to your self-talk. If your inner voice is constantly negative or critical, respond kindly and firmly, as a loving parent would (Thank you for your perspective, but it isn’t helpful right now.) or push back with questions (Is that true? How do you know? Who said that?).
  • Keep a journal. Write down your thoughts and feelings, without a filter and without judgment. Understand that you are not obligated to feel cheerful, optimistic or any particular way. Get to know your feelings, and name them: “Today, I’m feeling resentful” or “Today, I feel uneasy.” Accept your feelings for what they are instead of trying to deny, change or mask them.

Diet:
  • Avoid alcohol. It can interfere with sleep and mood and acts as a nervous system depressant.
  • Avoid other substances that might serve as “quick fixes,” like caffeine or sugar. These can do more harm than good.
  • Add a vitamin D supplement. Most of us don’t get enough vitamin D, especially in the winter, and it can be hard to obtain from food.

Exercise:
  • Engage in moderate exercise for at least 30 minutes three times per week, especially aerobic exercise like walking or jogging. Choose activities that you normally enjoy or that you’ve always wanted to try. If you’re having trouble finding the motivation or sticking to a schedule, take a class or find an exercise buddy.
  • Exercise outside, if you can. Spending time outdoors has been shown to alleviate stress and improve mood, and exposure to sunlight can help relieve the depression of seasonal affective disorder (SAD).

Lifestyle Factors:
  • Get adequate sleep—at least seven to eight hours a night. Try going to bed at roughly the same time every night and getting up at roughly the same time every morning.

Stress Management:
  • Make time for yourself to rest and recharge. This is especially important at busy times, like during the holidays or when you’re preparing for a presentation at work.
  • Delegate. Don’t withdraw, but maintain only a reasonable amount of responsibilities. If there’s a particular task you’re struggling with, find someone else to step in for a while. Let your family and friends help you.
Medication:
  • Antidepressants: Several antidepressants have been approved to treat forms of depression ranging from mild to severe. About 80% of people with major depression will respond well to the right antidepressant. If you elect to take an antidepressant, you will likely start with a low dose that slowly increases over time until the right therapeutic dose is achieved. Medications used to treat depression include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and aminoketone antidepressants.
  • Estrogen therapy: This hormone therapy is sometimes used with other treatments to relieve mood-related symptoms of menopause, such as irritability, mood swings and depression. And for women who become depressed due to sleep deprivation caused by night sweats, low-dose estrogen therapy may be enough to restore normal sleep and functioning.

Psychotherapy:
  • Cognitive behavioral therapy (CBT): CBT focuses on identifying distorted perceptions you may have of the world and of yourself, changing those perceptions, and discovering new patterns of thought and behavior.
  • Behavioral activation (BA) therapy: BA therapy helps you change what you do so you can change how you feel.
  • Interpersonal therapy (IPT): IPT acknowledges the childhood roots of depression but focuses on symptoms and current issues that may be causing problems, especially in relationships.

Alternative Therapies:
  • Phototherapy: If you notice that lack of sunlight is a trigger for you, try using a light box or wearing a visor or mask made specifically for seasonal affective disorder (SAD). Use for about 30 minutes a day, in the morning.
  • St. John’s Wort (Hypericum perforatum): This herbal remedy may help to relieve mild to moderate acute depression in some people. Studies find little to no effect in treating major depression.
What causes depression?
Depression is caused by abnormally low levels of certain chemicals in the brain called neurotransmitters, including serotonin, dopamine and norepinephrine. Low levels of the B vitamin folate may also contribute to depression. Certain people are genetically predisposed to have low levels of neurotransmitters; in addition, depression may be triggered by burnout, chronic stress, difficult life transitions, grief and loss, certain medical conditions and traumatic events.

What are the risk factors for depression?
Anyone can get depression, but certain people are more susceptible. There is a genetic component to depression, and those who have a family history of depression are at higher risk. Women are more likely to suffer from depression than men and more likely to experience successive bouts of depression. Prolonged stress, abuse, illness, drug and alcohol use, certain medications, significant losses and traumatic events can all trigger depression. Those with fewer satisfying social interactions are also at higher risk, and a strong social support system has been shown to be a key enabler of successful recovery from a depressive episode.

Are there different types of depression?
Yes. The primary types of depression in women are:
  • Major depression: Marked by a depressed mood that persists for at least two weeks and interferes with life activities (work, sleep and eating), as well as a loss of interest in previously pleasurable activities.
  • Dysthymia: A form of chronic, low-grade depression that persists for at least two years. Characterized by low energy, general negativity, and a sense of dissatisfaction and hopelessness.
  • Postpartum depression (PPD): Depressed mood or persistent anxious thoughts that typically occur within a month after the birth of a baby. Affects roughly 10%-15% of postpartum women.
  • Premenstrual dysphoric disorder (PMDD): A syndrome of severe depression, irritability and tension occurring seven to 14 days prior to the start of one’s menstrual period. Affects 3%-8% of women of childbearing age.
  • Seasonal affective disorder (SAD): Also called “winter depression.” Affects an estimated 10%-20% of Americans, with women more likely to suffer than men.

How is depression treated?
Most health experts agree the best way to treat depression is with a combination of psychotherapy and antidepressant medication. However, the recommended course of treatment may vary greatly from person to person, depending on the exact diagnosis.

What if I choose not to treat my depression?
If left untreated, depression can be devastating. An estimated 1% of women with a lifetime history of depression will eventually commit suicide. What’s more, depression is a risk factor for other medical conditions, such as heart disease and osteoporosis. It also may have adverse effects on the immune system.